Parathyroid Hormone Analogue (Anabolic) Pregnancy: Contraindicated in pregnancy and breast-feeding. Women of childbearing potential should use effective contraception; if pregnancy occurs, treatment should be discontinued.

Teriparatide

Brand names: Forsteo, Terrosa, Movymia

Used in: Osteoporosis

Teriparatide is a recombinant parathyroid hormone analogue used for severe osteoporosis. Unlike bisphosphonates it is anabolic (bone-building) and is given by daily subcutaneous injection for a limited lifetime treatment duration.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 20 micrograms

Route: Subcutaneous injection in the thigh or abdomen

Frequency: Once daily

Maximum total duration of treatment is 24 months; the 24-month course should not be repeated over a patient's lifetime. Patients should receive supplemental calcium and vitamin D if dietary intake is inadequate. Following cessation, patients may be continued on other osteoporosis therapies. Elderly: no dosage adjustment based on age is required. Hepatic impairment: no data available — use with caution. Patients must be trained in proper injection technique (pre-filled pen delivering 20 micrograms/80 microlitres). Experience in the younger adult population, including premenopausal women, is limited — initiate only if benefit clearly outweighs risk; women of childbearing potential should use effective contraception. Paediatric: safety and efficacy in children and adolescents under 18 years have not been established — must not be used in patients under 18 years or young adults with open epiphyses. Serum calcium peaks 4–6 hours post-dose; if serum calcium is measured, sample at least 16 hours after the most recent injection. Source: eMC SPC for Forsteo 20 micrograms/80 microlitres solution for injection.

Dose adjustments

Renal

Must not be used in severe renal impairment (contraindicated). Use with caution in moderate renal impairment. No special caution required in mild renal impairment.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

Recommended dosage is 20 mcg subcutaneously once a day ( 2.1 ) Consider supplemental calcium and Vitamin D based on individual patient needs ( 2.1 ) Administer as a subcutaneous injection into the thigh or abdominal region ( 2.2 ) Administer initially under circumstances in which the patient can sit or lie down if symptoms of orthostatic hypotension occur ( 2.2 ) Use of teriparatide for more than 2 years during a patient's lifetime should only be considered if a patient remains at or has returned to having a high risk for fracture ( 2.3 ) 2.1 Recommended Dosage The recommended dosage is 20 mcg given subcutaneously once a day. Instruct patients to take supplemental calcium and vitamin D if …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2025-05-27. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

Hypersensitivity to the active substance or to any of the excipients
Pregnancy and breast-feeding
Pre-existing hypercalcaemia
Severe renal impairment
Metabolic bone diseases (including hyperparathyroidism and Paget's disease of bone) other than primary osteoporosis or glucocorticoid-induced osteoporosis
Unexplained elevations of alkaline phosphatase
Prior external beam or implant radiation therapy to the skeleton
Patients with skeletal malignancies or bone metastases should be excluded from treatment

Side effects

Pain in limb (very common)
Nausea and vomiting (common); also hiatus hernia, gastro-oesophageal reflux disease
Headache, dizziness, sciatica, syncope (common); vertigo (common)
Hypotension, palpitations, dyspnoea (common); anaemia, hypercholesterolaemia, depression, muscle cramps (common)
Mild and transient injection site events (pain, swelling, erythema, localised bruising, pruritus, minor bleeding); hypercalcaemia and hyperuricaemia (uncommon); anaphylaxis (rare)

Interactions

Digitalis/digoxin — teriparatide transiently increases serum calcium and hypercalcaemia may predispose to digitalis toxicity; use with caution in patients taking digitalis (a single dose did not alter the cardiac effect of digoxin in 15 healthy subjects)
Hydrochlorothiazide — evaluated in pharmacodynamic interaction studies (SPC §4.5 text truncated in the fetched source; verify full section)

Clinical monograph

How it works

It is a recombinant fragment of parathyroid hormone; intermittent administration preferentially stimulates osteoblast activity, increasing bone formation.

Prescribing in practice

It is contraindicated where there is increased osteosarcoma risk, including Paget's disease of bone, prior skeletal radiotherapy and unexplained raised alkaline phosphatase.
Transient hypercalcaemia can occur after dosing.
Lifetime treatment duration is limited and it is given as a once-daily subcutaneous injection.

Monitoring

Monitor calcium status and clinical response; review against the maximum lifetime treatment duration.

Counselling the patient

Inject under the skin once daily as shown, and rotate injection sites.
Dizziness can occur after the first few doses; give the injection where you can sit or lie down.
This is a time-limited course; follow-on treatment is usually needed to maintain the benefit.

Evidence & guidelines

Specialist-initiated anabolic option for severe osteoporosis (NICE).

Reference: NICE TA161; NICE TA160; Forteo SPC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Pathways